Strengthening Families Living with HIV in Kenya

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PROJECT SUMMARY/ABSTRACT HIV is a social disease with biomedical implications, wreaking havoc on families and communities far beyond what can be addressed in clinics alone. The majority of research and intervention funding goes towards clinical care to suppress viral transmission. Behavioral, social, economic and psychological consequences and determinants of HIV progression go largely unaddressed in global funding priorities. Families with HIV experience more violence, poverty, food insecurity, dysfunction, social exclusion and street- migration by their children than families who are not living with HIV. Research is required to determine the most effective, low-cost and scalable mechanisms to address the wide range of factors unaddressed by clinical care. This project adapts our intervention, Kuja Pamoja (“Come Together”), to empower families living with HIV. We developed Kuja Pamoja in the broader population in rural Kenya to prevent street-migration of children and support community reintegration of former street children. Kuja Pamoja-HIV will utilize a group- savings model to develop social capital (e.g. trust, expectations of mutual benefit and normative influence). Accrued social capital is then leveraged to address a wide range of determinants (e.g. economic and food insecurity, family violence and dysfunction, social exclusion, and ART adherence), mental health (e.g. reduce depression, anxiety and post-traumatic stress), and behavioral health (e.g. improved retention in care and ART adherence). Among families living with HIV, we aim to improve mental health and viral suppression among adolescents and adults with HIV. The project will develop a new care model that can scale across low-income settings and improve HIV-related outcomes. If successful, the model will provide a template to improve health care delivery and outcomes in other areas – e.g. Maternal/child health, chronic disease conditions, and tuberculosis. The project also contributes to my career development. A well-established team of mentors and advisors will serve to advance my career by guiding me through coursework, reading, conferences, and other sources of professional research networking to ensure that I gain essential research skills, mental health and clinical knowledge, and improved understanding of the determinants of health. Specifically, I will undergo mentored coursework in implementation science, intervention mapping, mental health, interventions to improve economic and food security, and advanced skills in statistical analysis and epidemiological research design. I will meet with established researchers with NIH funding. Through these activities, I will receive mentorship and formal training in grantsmanship, longitudinal data analysis, cohort retention, intervention development and mapping, implementation science and improved comprehension of family violence and mental health. The career development portion plus the research project will lead to the development of a competitive R01 application.